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Individual

JAYNE PENELOPE KIDDER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA

Contact information

Practice address
127 WOODSIDE AVE SE, NORTH CANTON, OH 44720-3236
(513) 509-2579
(234) 209-9010
Mailing address
127 WOODSIDE AVE SE, NORTH CANTON, OH 44720-3236
(513) 509-2579
(234) 209-9010

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0002003
OH
101YM0800X
Mental Health Counselor
0002003
OH
101YP2500X
Professional Counselor
Primary
0002003
OH

Other

Enumeration date
06/07/2023
Last updated
06/07/2023
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